The foundation of
insurance rests on
the concept of
protecting
individuals from
risk, uncertain in
terms of scope and
timing but
predictable based on
large numbers.
People buy home
insurance to protect
against fire and
other risks that can
generate property
loss. They buy
disability coverage
to protect against
the risk of a
condition that
impacts the ability
to earn a living,
and auto insurance
to provide
protection for
themselves and
others in the case
of an accident.
No consumer would ever expect to
gain access to home
insurance to protect
their home the day
after a garage fire
or obtain collision
coverage the day
after automobile
accident — and most
consumers try to
reduce their chance
of bad things
happening through a
variety of risk
avoidance and risk
reduction
techniques. We buy
smoke detectors,
drive within the
speed limit (most of
the time), and buy
insurance to protect
us from unforeseen
events.
Health insurance
presents many more
challenges, however.
Many consumers
expect to buy
insurance coverage
only when they need
it, and many don’t
see much value in
reducing their
risks.
Even with these
challenges,
consumers looking
for coverage have
many options for
coverage in the
individual health
insurance market —
even individuals
with medical
conditions.
Following are four
quick tips to help
you find coverage
for your risky
clients.
1. Get them married
off to someone with
group coverage
The fact remains
joining a spouse’s
policy or finding a
new job that
provides access to
group coverage is a
solid approach for
ailing prospects
seeking to obtain
coverage. Since
prices are set based
on the group’s claim
experience, this
gives your client a
good chance to gain
quality coverage at
a reasonable price.
Gaining access to an
association or
affinity group
program also may
provide a short-term
solution —
especially if the
group is newly
formed. However,
premium levels can
become problematic
in the longer run,
as the pool matures
and the healthy
individuals seek
cheaper coverage
elsewhere.
In addition, some
states allow you to
form groups of one
or two individuals,
but that requires
some effort and is
not consistent
across states.
Overall, these
options have limited
viability in a
recessionary
environment, and if
your client or their
loved one has
commitment issues
that preclude the
marriage option, one
of your best bets is
to find them
permanent private
insurance coverage.
2. Get friendly with
private market
underwriters
Everything in
business is about
relationships, so
make sure your
agency team is
actively courting
and building
relationships with
carriers’
underwriting staffs.
Agents who have
aggregated their
volume with a few
select carriers and
established close
relationships with
underwriting teams
seem to manage the
art of underwriting
better than others,
to the benefit of
their clients.
Underwriting is a
conservative
profession, but most
really do want to
find ways to write
business. And the
good news is that
acceptance rates for
private market
coverage have
increased by about
20 percent over the
last five years.
Contributing to this
acceptance surge are
riders that exclude
problematic
conditions for a
specified period of
time and
counter-offer
programs that
provide higher
cost-sharing
products at standard
rates.
Market reform will
only increase
acceptance rates
that are averaging
around 85 percent
today for
producer-driven
business. Each
carriers’ methods
are different and
constantly changing
based on book
performance and
competitive factors,
so close
relationships with
underwriters allow
you to get a deeper
understanding of the
carrier’s alchemy
behind its
underwriting manuals
and, in most cases,
will help provide
you general
acceptance rules and
even
pre-underwriting
opinions for your
clients.
3. Check COBRA
options, but be wary
of limitations
The government’s
stimulus plan
provides up to 65
percent of COBRA
premiums, and your
client may have
rights to take
advantage of this
opportunity. Visit
sites such as this
one to learn more or
www.cms.hhs.gov/cobracontinuationofcov
to get more details.
However, remember
that:
-
COBRA is not
permanent
insurance.
-
Your clients
lose COBRA
coverage if the
employer drops
coverage or goes
out of business.
-
Any conditions
developed during
the COBRA period
could become
pre-existing and
excludable
conditions for
private
insurance
coverage.
4. Explore
government options
Most states provide
a range of options
including Medicaid,
low-income safety
net programs such as
SCHIP, and high-risk
pools for
individuals with
significant medical
conditions.
Limitations abound,
but a great source
to figure what’s
available in each
state is
www.statehealthfacts.org,
provided by the
Kaiser Family
Foundation.
The fact is that it
can be difficult to
find qualified
prospects for health
insurance, given
that so many people
have medical issues.
However, just
because your
prospect is or has
been sick does not
mean they are doomed
to uninsurability.
With a little work
and creative
planning on your
part, you may be
able to find your
prospect proper
coverage that can
protect them from
incurring further
costs. |